Last spring the Ohio Department of Medicaid (ODM) released a request for proposals for plans to serve the Next Generation of MyCare program. Since then, we have been in a quiet period, which meant that the information we could share publicly was limited. We are pleased to say that as of March 11, we are out of the quiet period. That means ODM will begin sharing more details through newsletters, presentations, and other channels about what we are doing to prepare for Next Generation MyCare. ODM has begun convening a MyCare Ohio advisory workgroup to engage stakeholders on the readiness, implementation, and post-implementation work related to the Next Generation MyCare program.
About the Next Generation MyCare Program
On November 1, 2024, ODM awarded four managed care organizations to serve as the Next Generation MyCare plans.
For more than a year, ODM has met with members, providers, and other stakeholders across the state to understand their experiences with the MyCare Ohio program. This feedback will inform ODM and the newly selected plans as they work together to implement a better person-centered experience for Ohioans across the state. ODM’s announcement and additional information can be found in the press release.
ODM awarded four managed care organizations as ODM’ Next Generation MyCare plans. The selected plans include a continued partnership of some of the MyCare Ohio plans who have served in the current demonstration as well as the addition of new plans that have served in the Next Generation managed care program to allow members more choices to meet their healthcare needs. The four Next Generation MyCare plans are:
The announcement of the Next Generation MyCare plans does not immediately impact current providers of the MyCare Ohio program. Current MyCare Ohio providers can continue serving members until the transition in January 2026.
Prior to all four Next Generation MyCare plans beginning in January 2026, members who live in one of the 29 current MyCare counties may pick their Next Generation MyCare plan early, and their services under that plan will start on January 1, 2026.
Starting in January 2026, all four plans will support Ohioans who are dually eligible for both Medicare and Medicaid healthcare coverage in each of the 29 counties where MyCare Ohio is currently available. Members who live in one of the 29 current MyCare counties may pick their Next Generation MyCare plan early, and their services under that plan will start on January 1, 2026, as explained above. Statewide expansion of the MyCare program will follow as quickly as possible. During the expansion period, members in each county will be able to choose from all four plans as the Next Generation MyCare program rolls out to their county.
We will continue to provide details about expected changes and offer assistance in navigating the changes ahead of January 2026.
Ohio Medicaid providers interested in contracting with the Next Generation MyCare plans can do so by contacting the plan(s) they prefer.
To learn more about the program refer to the resources below:
If you have questions, please contact the following:
- For questions related to OMES submitted claims, prior authorizations, and billing, contact the ODM Integrated Helpdesk (IHD) at IHD@medicaid.ohio.gov or call 800-686-1516. Provider representatives are available Monday - Friday 8 a.m.-4:30 p.m. Interactive Voice Response System (IVR) provides 24/7/365 access to information regarding client eligibility, claim and payment status, and provider information.
- For questions related to pharmacy claims and prior authorizations, call the Gainwell Single Pharmacy Benefit Manager at 833-491-0344 or email OH_MCD_PDM@GainwellTechnologies.com.
- For questions related to PASSPORT or Assisted Living claims and/or service authorizations, call the local Area Agency on Aging at 866-243-5678.
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